When is the best time to take blood pressure medicine?

Generally, if your blood pressure is not too high, your doctor will recommend implementing some lifestyle strategies before starting blood pressure medication. These may include:

• taking regular exercise
• maintaining an optimal body mass index (BMI)
• lowering sodium intake if it’s more than the recommended daily allowance of 2.3 grams (g)
• limiting fat intake
• limiting alcohol intake
• increasing potassium intake
• following the Dietary Approaches to Stop Hypertension (DASH) diet
• avoiding smoking and, where possible, second-hand smoke

If the lifestyle adaptations alone are not working, the American Heart Association (AHA) recommends blood pressure medication, but there is some debate around the best time to take them. 

What the evidence says 

Chronotherapy refers to treating diseases and medical conditions based on the body’s circadian rhythm. It may offer some insight into the debate around when to take blood pressure medications. 

Some medications are time-sensitive. If you take them at the wrong time, you may not tolerate them well, or they may not work correctly. Chronotherapy involves taking medication at a time that fits in with your circadian rhythm, decreasing side effects and increasing drug efficacy.

As a general rule, your blood pressure naturally decreases at night. Studies indicate taking at least one high blood pressure medication at night may reduce your chances of developing life threatening cardiovascular events, such as heart attacks or strokes.

The European Heart Journal also suggested that taking one or more blood pressure medications at night or before bed improves blood pressure control without increasing the medication’s side effects.

However, scientists need to conduct more research to determine if this is true for all people and medications.

Differences between studies

While scientists and researchers continue to study the chronotherapeutic aspects of high blood pressure medications, most doctors and other healthcare professionals recommend people take their medications at a time that suits them.

The most important aspect of blood pressure treatment is taking the medication consistently. So it is perfectly fine to take your medication when you are most likely to remember it.

You may also consider the side effects when taking your medication. For example, if a drug makes you feel tired, consider taking it at night or before bed. Or, if taking it on an empty stomach causes an upset stomach, take it with food.

A doctor may prescribe a diuretic for your blood pressure. Diuretics draw excess fluid from your blood vessels and excrete it as urine. As a result, you may notice an increase in the number of trips you make to the bathroom. For this reason, your doctor may recommend you take your diuretic in the morning to avoid disrupting your sleep with frequent bathroom visits.

Acetaminophen and blood pressure

According to a 2020 trial, taking 4 g of acetaminophen (Tylenol) daily increases blood pressure. If your blood pressure is within the optimal range, this may not affect you. However, it may become a problem for someone with high blood pressure.

Tell your doctor about all the medication and supplements you regularly take, as some interact with high blood pressure medication. This can make them less effective or cause harmful side effects.

Common blood pressure medications

Your doctor may prescribe one or more blood pressure medications to control your blood pressure if lifestyle strategies are not working.

Some common blood pressure medications include:

• Thiazide-type diuretics, such as indapamide (Lozol) and chlorthalidone (Thalitone).
• Calcium channel blockers (CCBs), such as amlodipine (Norvasc) or diltiazem (Cardizem).
• Angiotensin-converting enzyme (ACE) inhibitors, such as enalapril (Vasotec) or Lisinopril (Qbrelis).
• Angiotensin II receptor blockers (ARBs), such as benicar (Olmesartan) or cozaar (Losartan).

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Contacting a doctor

Consider contacting your doctor if your blood pressure measures over 140/90.

Also, talk with your doctor:

• before changing the dosage or stopping a blood pressure medication
• before changing the timing of your medication
• before adding new herbs or supplements to your diet

Talk with your doctor before taking medications that may increase your blood pressure, such as phenylephrine (Vazculep). 

Summary

Although more research is needed, studies indicate the best time to take your blood pressure medication is at night or before bed, as it may work best with your circadian rhythm.

However, if you have difficulty remembering to take the medication, try to take it at a time you will remember. You may also need to consider other factors, such as side effects and when the medication works the best. But taking the medication regularly is more important than when you take it.

Always follow a doctor’s recommendations for taking your blood pressure medication and contact them before making changes or stopping a medication.

Also, talk with a doctor before adding new herbs or supplements to your diet. Herbs and supplements can change the effectiveness of blood pressure medications or even cause harmful side effects.

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